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Organizing end of life in hospital palliative care: A Canadian example

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  • Krawczyk, Marian

Abstract

Hospitals remain the most common location of death in a significant number of countries, and specialist palliative care is positioned as a crucial resource for improving hospital care for those nearing end of life. Little is known, however, about a substantive aspect of this work: how hospital palliative clinicians anticipate and organize a patient's dying trajectory. In this paper I draw from a larger original ethnographic research study of palliative specialists in two Canadian hospitals. Abductive analysis resulted in framing their work as affective labour, both reflecting and re-creating a larger affective economy shaping the affective states of everyone involved in the provision and uptake of care. I articulate six analytically ideal outcomes of clinicians' affective labour that organize end of life, including: 1) proactive co-authorship of disease trajectory; 2) mutual acknowledgement of a dying trajectory; 3) naturalizing direction and outcome of care, 4) ensuring a minimum of social disruption, 5) identification as compassionate and efficient care providers, and 6) increased specialist knowledge and interventions. In so doing, clinicians' practices become understandable as labour to meet a diversity of – at times conflicting – individual, organizational, and societal mandates that necessarily include, but extend well beyond, the patient and her immediate social network. This is the first study to consider hospital palliative care as an affective economy, and presents a theoretically innovative and empirically grounded model to advance new ways of conceptualizing hospital palliative care. I conclude by considering how this model, and the unique insights it affords, can inform the future development of end of life care in hospital settings.

Suggested Citation

  • Krawczyk, Marian, 2021. "Organizing end of life in hospital palliative care: A Canadian example," Social Science & Medicine, Elsevier, vol. 291(C).
  • Handle: RePEc:eee:socmed:v:291:y:2021:i:c:s0277953619304861
    DOI: 10.1016/j.socscimed.2019.112493
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    References listed on IDEAS

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    1. Joanna Broad & Merryn Gott & Hongsoo Kim & Michal Boyd & He Chen & Martin Connolly, 2013. "Erratum to: Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available stati," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 327-327, April.
    2. Joanna Broad & Merryn Gott & Hongsoo Kim & Michal Boyd & He Chen & Martin Connolly, 2013. "Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 257-267, April.
    3. Seymour, Jane Elizabeth, 2000. "Negotiating natural death in intensive care," Social Science & Medicine, Elsevier, vol. 51(8), pages 1241-1252, October.
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